Evaluation of a multiple sclerosis cluster among nurses in an inpatient oncology ward

Details

• Personal Author:
  Couch, James R. ; De Perio, Marie A. ; Page, Elena H.
• Description:
  In January 2011 the National Institute for Occupational Safety and Health (NIOSH) received a request from three employees in the inpatient oncology unit of a university hospital in Wisconsin concerning a potential multiple sclerosis (MS) cluster. Three of the 41 nurses in the unit were diagnosed with MS between 2007 and 2010, and employees were concerned about their exposures to chemotherapy drugs and helicopter exhaust. The employees were also concerned that exposure to acrolein, a metabolite from exposure to some chemotherapy drugs that is also present in helicopter engine exhaust, may be associated with MS. The 39-bed unit housed hematology/oncology, bone marrow transplant, and palliative care patients. At the time of this evaluation, the average occupancy was 68%, and 17% of the patients received chemotherapy daily. The hospital oncology unit administers a wide variety of chemotherapy drugs and daily administration amounts vary depending upon patient load. The decision to concentrate sampling efforts on cyclophosphamide and ifosfamide was made based upon their frequent use at the hospital and that fact that these drugs are metabolized into acrolein in the human body. A pharmacy in the unit was staffed by two pharmacists daily. Hazardous drugs were delivered to the unit by vacuum tube system or by cart. These drugs left the pharmacy enclosed in resealable plastic bags that reportedly were cleaned before being delivered to the unit. In the unit's pharmacy, hazardous drugs were mixed and intravenous administration bags were prepared for daily administration. Pills were crushed into powders and routinely added to food to aid patients that had difficulty swallowing pills. Registered nurses were the only hospital personnel allowed to clean up chemotherapy spills; they used commercially available kits. All registered nurses were required to take a 3-day chemotherapy certification course and a 1-day practicum, and pass a test before administering these drugs. The course included a module on safe handling of cytotoxic agents; however, hazard communication training for other personnel who handled or came into contact with these drugs was not provided. Nurses who handled chemotherapy drugs had annual, refresher computer-based training, which did not include the safe handling module. Employees who handled hazardous drugs were not part of a medical surveillance program. [Description provided by NIOSH]
• Subjects:
  Aldehydes Antineoplastic Agents Case Reports Drug Therapy Energy Metabolism Environmental Monitoring Formaldehyde Hazardous Substances Health Care Facilities Workforce And Services Health Personnel Manufacturing And Industrial Facilities Neoplasms Nervous System Nervous System Disorders Occupational Health Personal Protective Equipment Safety Staff Development Surveys And Questionnaires Vehicle Emissions Ventilation Women Workplace

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• Keywords:
  Air-quality-measurement Antineoplastic-agents Case-studies Central-nervous-system-disorders Chemotherapy Control-systems Cytotoxins Drug-therapy Drugs Exhaust-gases Exposure-assessment Exposure-levels Gloves Hazardous-materials Health-care-personnel Health-surveys HETA 2011-0047-3143 Materials-handling Medical-monitoring Metabolic-activation Nurses Oncogenic-agents Personal-protective-equipment Sampling Training Ventilation-systems Work-practices Workplace-studies

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• ISSN:
  1545-9624
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Ohio ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  12
• Issue:
  5
• NIOSHTIC Number:
  nn:20046051
• Citation:
  J Occup Environ Hyg 2015 May; 12(5):D54-D59
• Contact Point Address:
  Elena Page, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 4676 Columbia Parkway, MS R-10, Cincinnati, OH 45226
• Email:
  EPage@cdc.gov
• CAS Registry Number:
  Acrolein (CAS RN 107-02-8) ; Carbon monoxide (CAS RN 630-08-0) ; Cyclophosphamide (CAS RN 50-18-0) ; Ifosfamide (CAS RN 3778-73-2)
• Federal Fiscal Year:
  2015
• Peer Reviewed:
  True
• Source Full Name:
  Journal of Occupational and Environmental Hygiene
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:197c733fc677a3370350c52e579ba73fff95fd6831c42cb76378b0275843169e7f6b33d36236f1b7970f08030cefffe5b567ac7f0f587c8b22726ce88be18e7e
• Download URL:
  https://stacks.cdc.gov/view/cdc/201233/cdc_201233_DS1.pdf
• File Type:
  [PDF - 93.14 KB ]